Recent estimates suggest that approximately 23 million Americans are addicted to drugs and/or alcohol. In 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that approximately 2.5 million people received care at some type of treatment facility. SAMHSA also recently estimated that the treatment and recovery industry market is approximately $35 billion per year. In other words, it is big business.
Because the treatment and recovery industry is big business, it has been susceptible to significant incidents of fraud and abuse, as reported by, for example, NBC News in June of 2017 regarding aspects of the drug treatment industry in Florida. NBC wrote that, “an investigation by NBC News has found that many of these vulnerable patients have become grist in an insurance fraud mill. Crooked treatment centers partner with “body brokers” and operators of so-called “sober homes” to find patients with good health insurance. Brokers and sober home owners offer those trying to get clean free rent and grocery store gift cards, cigarettes and manicures in exchange for going to a specific treatment center, which pays kickbacks for every client.” See, Florida's Billion-Dollar Drug Treatment Industry Is Plagued by Overdoses, Fraud by Riordan Seville, Lisa, Schecter, Anna R., and Rappleye, Hannah (accessed at http://www.nbcnews.com/feature/megyn-kelly/florida-s-billion-dollar-drug-treatment-industry-plagued-overdoses-fraud-n773376).
The incidence of drug and alcohol dependence, including in recent years, a significant spike in opioid dependence, has only increased the prevalence of treatment and recovery facilities. And, because drug and alcohol treatment is often covered by medical insurance, it has, as NPR recently stated, “created new opportunities for insurance fraud.” See, Beach Town Tries To Reverse Runaway Growth of ‘Sober Homes’ by Greg Allen (accessed at http://www.npr.org/sections/health-shots/2017/08/10/537882989/beach-town-tries-to-reverse-runaway-growth-of-sober-homes).
Because alcohol and drug addiction is so serious and potentially life threatening, however, it is not only big business, but it is extremely serious business, which needs to be monitored and controlled to prevent fraud and abuse at the hands of the addict or alcoholic.
In the treatment and recovery facility industry, it is often the case that a counselor or mental health professional will recommend that a particular person enter into treatment.
This process, however, can be interfered with, or even hijacked, by sophisticated marketing schemes in which patient brokering occurs. In some cases, “middle men” or patient brokers will present a candidate for treatment to a facility, and the facility will allow the candidate to stay there rent free and provide a “kick back” to the patient broker. The facility benefits because the candidate will be drug tested and allegedly treated (e.g., via group counseling, acupuncture, massage, physical fitness) for a stretch of time, and insurance companies will pay the facility money for providing or administering such services. Such patient brokering is a problem in and of itself. In addition, many of the facilities participating in such schemes are ill-equipped to actually treat their patients, and the instances of drug abuse and drug overdoses by persons admitted to such facilities actually increases, inhibiting recovery efforts.
For the foregoing reasons, there is a need for a system that addresses the foregoing concerns and issues, and minimizes, if not eliminates, the opportunities for fraud, while simultaneously enhancing client service in terms of placing his or her health needs first. This is accomplished through a tailored, real-time system and method of ascertaining inventory of beds or spaces in a treatment facility, recovery facility, sober home, halfway house, psychiatric ward, or the like in a way that eliminates “middle men” and patient brokers that, at present, are involved in the fraudulent schemes and taking of “kick backs” that are unfortunately so prevalent in this field at this time.